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Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 2/2017

01-06-2017 | Motion Preserving Spine Surgery (C Kepler, section editor)

Lumbar disc replacement surgery—successes and obstacles to widespread adoption

Authors: Stephan N. Salzmann, Nicolas Plais, Jennifer Shue, Federico P. Girardi

Published in: Current Reviews in Musculoskeletal Medicine | Issue 2/2017

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Abstract

Purpose of review

Lumbar disc replacement has been a surgical alternative to fusion surgery for the treatment of lumbar degenerative disc disease (DDD) for many years. Despite enthusiasm after the approval of the first devices, implantation rates have remained low, especially in the USA. The goal of this review is to provide a general overview of lumbar disc replacement in order to comprehend the successes and obstacles to widespread adoption.

Recent findings

Although a large amount of evidence-based data including satisfactory long-term results is available, implantation rates in the USA have not increased in the last decade. Possible explanations for this include strict indications for use, challenging surgical techniques, lack of device selection, fear of late complications or revision surgeries, and reimbursement issues.

Summary

Recent publications can address some of the past concerns, but there still remain obstacles to widespread adoption. Upcoming data on long-term outcome, implant durability and possible very late complications will determine the future of lumbar disc replacement surgery.
Literature
1.
Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64:2028–37.CrossRefPubMed
2.
Katz J. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Jt Surg. 2006;88:21–4.
3.
• Garcia R, Yue JJ, Blumenthal S, et al. Lumbar total disc replacement for discogenic low back pain. Spine (Phila Pa 1976). 2015;40:1873–81. Recent RCT evaluating the safety and effectiveness of activL CrossRef
4.
5.
Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine (Phila Pa 1976). 2007;32:2119–26.CrossRef
6.
Yoshihara H, Yoneoka D. National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009. Spine J. 2015;15:265–71.CrossRefPubMed
7.
Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM, Goldfarb N, Vaccaro AR, Hilibrand AS. Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine (Phila Pa 1976). 2008;33:1701–7.CrossRef
8.
Deyo RA, Nachemson A, Mirza SK. Spinal-fusion surgery—the case for restraint. N Engl J Med. 2004;350:722–6.CrossRefPubMed
9.
Eliasberg CD, Kelly MP, Ajiboye RM, SooHoo NF. Complications and rates of subsequent lumbar surgery following lumbar total disc arthroplasty and lumbar fusion. Spine (Phila Pa 1976). 2016;41:173–81.CrossRef
10.
Ghiselli G, Wang JC, Bhatia NN, Hsu WK, Dawson EG. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am. 2004;86–A:1497–503.CrossRefPubMed
11.
Xia X-P, Chen H-L, Cheng H-B. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013;38:597–608.CrossRef
12.
Park CK, Ph D. Total disc replacement in lumbar degenerative disc diseases. J Korean Neurosurg. 2015;58:401–11.CrossRef
13.
14.
Van Den Eerenbeemt KD, Ostelo RW, Van Royen BJ, Peul WC, Van Tulder MW. Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature. Eur Spine J. 2010;19:1262–80.CrossRefPubMedPubMedCentral
15.
16.
17.
Uschold TD, Fusco D, Germain R, Tumialan LM, Chang SW. Cervical and lumbar spinal arthroplasty: clinical review. AJNR Am J Neuroradiol. 2012;33:1631–41.CrossRefPubMed
18.
19.
Baxter RM, Macdonald DW, Kurtz SM, Steinbeck MJ. Severe impingement of lumbar disc replacements increases the functional biological activity of polyethylene wear debris. J Bone Joint Surg Am. 2013;95:e751–9.CrossRefPubMed
20.
Phillips FM, Garfin SR. Cervical disc replacement. Spine (Phila Pa 1976). 2005;30:S27–33.CrossRef
21.
• Guyer RD, Pettine K, Roh JS, Dimmig TA, Coric D, McAfee PC, Ohnmeiss DD. Five-year follow-up of a prospective, randomized trial comparing two lumbar total disc replacements. Spine (Phila Pa 1976). 2016;41:3–8. Recent RCT comparing outcomes of TDR with Kineflex-L and CHARITE. CrossRef
22.
Wilke HJ, Schmidt R, Richter M, Schmoelz W, Reichel H, Cakir B. The role of prosthesis design on segmental biomechanics semi-constrained versus unconstrained prostheses and anterior versus posterior centre of rotation. Eur Spine J. 2012; doi:10.​1007/​s00586-010-1552-1.
23.
Galbusera F, Bellini CM, Zweig T, Ferguson S, Raimondi MT, Lamartina C, Brayda-Bruno M, Fornari M. Design concepts in lumbar total disc arthroplasty. Eur Spine J. 2008;17:1635–50.CrossRefPubMedPubMedCentral
24.
Meir AR, Freeman BJC, Fraser RD, Fowler SM. Ten-year survival and clinical outcome of the AcroFlex lumbar disc replacement for the treatment of symptomatic disc degeneration. Spine J. 2013;13:13–21.CrossRefPubMed
25.
26.
Büttner-Janz K, Guyer RD, Ohnmeiss DD. Indications for lumbar total disc replacement: selecting the right patient with the right indication for the right total disc. Int J spine Surg. 2014; doi:10.​14444/​1012.PubMed
27.
Tropiano P, Huang RC, Girardi FP, Cammisa FP, Marnay T. Lumbar total disc replacement. Surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1):50–64.CrossRefPubMed
28.
Brau SA, Delamarter RB, Kropf MA, Watkins RG, Williams LA, Schiffman ML, Bae HW. Access strategies for revision in anterior lumbar surgery. Spine (Phila Pa 1976). 2008;33:1662–7.CrossRef
29.
Frelinghuysen P, Huang RC, Girardi FP, Cammisa FP. Lumbar total disc replacement part I: rationale, biomechanics, and implant types. Orthop Clin North Am. 2005;36:293–9.CrossRefPubMed
30.
31.
32.
Siepe CJ, Heider F, Wiechert K, Hitzl W, Ishak B, Mayer MH. Mid- to long-term results of total lumbar disc replacement: a prospective analysis with 5- to 10-year follow-up. Spine J. 2014;14:1417–31.CrossRefPubMed
33.
Yue JJ, Garcia R, Miller LE. The activL(®) artificial disc: a next-generation motion-preserving implant for chronic lumbar discogenic pain. Med Devices (Auckl). 2016;9:75–84.
34.
• LS Bao, Hai Y, Kong C, Wang QYI, Su Q, Zang L, Kang N, MX Long, Wang Y. An 11-year minimum follow-up of the Charite III lumbar disc replacement for the treatment of symptomatic degenerative disc disease. Eur Spine J 2015: 24:2056–2064. Recently published study presenting results of TDR with the Charite III with a mean follow-up of 11.8 years.
35.
• Park S-J, Lee C-S, Chung S-S, Lee K-H, Kim W-S, Lee J-Y. Long-term outcomes following lumbar total disc replacement using ProDisc-II average 10-year follow-up at a single institute. Spine (Phila Pa 1976). 2016;4(1):971–7. Recently published article highlighting the importance of patient selection for successful outcomes. CrossRef
36.
Aghayev E, Etter C, Bärlocher C, et al. Five-year results of lumbar disc prostheses in the SWISSspine registry. Eur Spine J. 2014;23:2114–26.CrossRefPubMed
37.
Nie H, Chen G, Wang X, Zeng J. Comparison of total disc replacement with lumbar fusion: a meta-analysis of randomized controlled trials. J Coll Physicians Surg Pak. 2015;25:60–7.PubMed
38.
Jacobs W, Van der Gaag NA, Tuschel A, de Kleuver M, Peul W, Verbout AJ, Oner FC. Total disc replacement for chronic back pain in the presence of disc degeneration. Cochrane database Syst Rev 2012:CD008326.
39.
Wei J, Song Y, Sun L, Lv C. Comparison of artificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials. Int Orthop. 2013;37:1315–25.CrossRefPubMedPubMedCentral
40.
Rao M-J, Cao S-S. Artificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2014;134:149–58.CrossRefPubMed
41.
Yajun W, Yue Z, Xiuxin H, Cui C. A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease. Eur Spine J. 2010;19:1250–61.CrossRefPubMedPubMedCentral
42.
• Ding F, Jia Z, Zhao Z, Xie L, Gao X, Ma D, Liu M. Total disc replacement versus fusion for lumbar degenerative disc disease: a systematic review of overlapping meta-analyses. Eur Spine J 2016: 1–10. This article evaluates the published meta-analyses of RCTs comparing lumbar TDR with fusion.
43.
Zigler J, Delamarter R, Spivak JM, et al. Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine (Phila Pa 1976). 2007;32:1155–62. discussion 1163
44.
Blumenthal S, McAfee PC, Guyer RD, Hochschuler SH, Geisler FH, Holt RT, Garcia R, Regan JJ, Ohnmeiss DD. A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes. Spine (Phila Pa 1976). 2005;30(1565–75):–91.
45.
Sasso RC, Foulk DM, Hahn M. Prospective, randomized trial of metal-on-metal artificial lumbar disc replacement: initial results for treatment of discogenic pain. Spine (Phila Pa 1976). 2008;33:123–31.CrossRef
46.
Gornet MF, Burkus JK, Dryer RF, Peloza JH. Lumbar disc arthroplasty with MAVERICK disc versus stand-alone Interbody fusion. Spine (Phila Pa 1976). 2011;36:E1600–11.CrossRef
47.
Hellum C, Johnsen LG, Storheim K, Nygaard OP, Brox JI, Rossvoll I, Rø M, Sandvik L, Grundnes O. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study. BMJ. 2011;342:d2786.CrossRefPubMedPubMedCentral
48.
Berg S, Tullberg T, Branth B, Olerud C, Tropp H. Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2-year follow-up. Eur Spine J. 2009;18:1512–9.CrossRefPubMedPubMedCentral
49.
Moreno P, Boulot J. Comparative study of short-term results between total artificial disc prosthesis and anterior lumbar interbody fusion. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:282–8.CrossRefPubMed
50.
51.
David T. Long-term results of one-level lumbar arthroplasty: minimum 10-year follow-up of the CHARITE artificial disc in 106 patients. Spine (Phila Pa 1976). 2007;32:661–6.CrossRef
52.
Lemaire JP, Carrier H, Ali. EHS clinical and radiological outcomes with the CHARITÉ™ artificial disc: a 10-year minimum follow-up. J Spinal Disord Tech 2005: 18:353–359
53.
Zigler J, Delamarter R. Five-year results of the prospective, randomized, multicenter, Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential arthrodesis for the treatment of single-level degenerative disc disease. J Neurosurg Spine. 2012;17:493–501.CrossRefPubMed
54.
Zigler J, Glenn J, Delamarter R. Five-year adjacent-level degenerative changes in patients with single-level disease treated using lumbar total disc replacement with ProDisc-L versus circumferential fusion. J Neurosurg Spine. 2012;17:504–11.CrossRefPubMed
Metadata
Title
Lumbar disc replacement surgery—successes and obstacles to widespread adoption
Authors
Stephan N. Salzmann
Nicolas Plais
Jennifer Shue
Federico P. Girardi
Publication date
01-06-2017
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 2/2017
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-017-9397-4

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